Provider Demographics
NPI:1528028966
Name:LIBERMAN, BERNARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:LIBERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EAST READ ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2478
Mailing Address - Country:US
Mailing Address - Phone:410-685-2347
Mailing Address - Fax:410-659-1943
Practice Address - Street 1:101 EAST READ ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2478
Practice Address - Country:US
Practice Address - Phone:410-685-2347
Practice Address - Fax:410-659-1943
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD550103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
G515BLMedicare ID - Type Unspecified